I got put into an awkward position today. A client asked, "Does reflexology work?"
Had I been in my own office, I would not have hesitated to answer freely. However, I was not in my office. I have recently taken a part time position in a spa and the spa offers reflexology treatments. I have twice been called upon to do reflexology treatments and even though I do not believe in reflexology as it is defined by most practitioners, I think a nice foot massage is pleasant and see no harm in it. In both cases, the clients had no expectations other than an extended foot massage and I am quite capable of that. But today I was asked a direct question and I definitely felt put on the spot.
What is Reflexology?
Reflexology is a type of massage using direct pressure on points on the feet and sometimes the hands. Reflexologists believe that certain points on the feet correspond to different organs and areas of the body and that one can affect these organs by applying pressure to their corresponding points. Reflexology was devised as a system in the 1930s by a physical therapist named Eunice Ingham. She worked with a physician, Dr. Riley, who was a practitioner of Zone Therapy. He believed that by applying pressure to various points on the hands, the tongue, the nose, and other areas, that one could relieve pain and cure the causes of the pain.
During a reflexology treatment, the therapist will systematically apply pressure, usually with their thumbs, to various points on the feet. For reasons I do not understand, they often apply very hard pressure to the point that it is painful. Both therapists and clients seem to think reflexology is supposed to hurt and if it does not, it will not be beneficial. Perhaps part of the attraction is that it feels good when they stop. I don't know.
Of course, the reality is that there is no map of the body on the feet or the hands. There is no evidence that one can affect any dysfunction of any particular organ by applying pressure to any particular point on the feet. Why do massage therapists persist in believing this and selling it to their clients? I have no idea. It seems so obviously silly, especially in this day and age, but people believe all sorts of peculiar ideas.
Does Reflexology Work?
When my client asked, "Does reflexology work?" I felt very put on the spot. As an ethical massage therapist devoted to evidence based massage therapy, I am compelled to be honest with my clients. I also, at that moment, feared that if I plainly admitted that reflexology is just nonsense that the client might get upset and tell the management and they would be very angry with me and punish me and/or fire me. I really did not want to lose my job at that moment. What to do?
"Massaging the feet can feel very good," I told my client, evading the question. "Yes, but does it work?" she asked. "In what way?" "Does it cure anything?" she asked. "There is no evidence that reflexology cures any disease," I told my client. "I didn't think so," she responded, and she sounded relieved. I think she was happy that she had a therapist who would talk sense.
I was relieved, too, that I could speak freely and not worry about any repercussions.
I told her that I was a minority in the field of massage therapy, that my goal was to practice evidence based massage therapy. I told her about the history of reflexology and she pointed out that it came about during a time when there was an explosion in natural therapies, such as those popularized by John Kellogg, most of which turned out to be of dubious value.
Lack of evidence
I am aware of a very few poorly constructed "studies" which purport to show that reflexology has therapeutic value. Although reflexologists shun scientific evidence, they will sometimes point to these studies. One which I read a number of years ago had a small sample of five or ten people. The subjects had tension headaches. They were given a half hour reflexology treatment while lying down and when they got up they felt better. Now, I am not a research scientist but immediately I saw how this "study" was obviously flawed. First of all, reflexologists do not concentrate only on the area of dysfunction. If you have gall bladder disease, they will still work on your entire foot. If reflexology worked, you should be able to improve your gall bladder disease by applying pressure to its corresponding point on the foot. You should not need to "treat" other areas. However, the most obvious flaw is that there was no control group to compare to. Most people will find lying down for half an hour and having their feet massaged to be a pleasant and relaxing experience. One would not have to exert pressure on any specific points. A general, nonspecific foot massage might be just as relaxing and effective. Lying down for half an hour and relaxing or having another part of the body massaged might be just as effective. In no way does this demonstrate any curative effect from reflexology itself. But this does not deter reflexologists from claiming therapeutic benefit from their treatment.
Fortunately, I was able to have an open and honest conversation with my client. I am not a particularly confrontational person and I do not aggressively challenge my colleagues who reject evidence to the contrary and subscribe to reflexology. I know I will be put in this position again. If the client wants an extended foot massage, I will be happy to oblige. If they ask me if reflexology works, though, I will have to diplomatically tell them there is no evidence to suggest that it has any therapeutic value beyond the placebo effect or relaxation.